Abstract

Background and purpose Presence of aphasia or severe neurological deficits is considered an indication for pre-procedural intubation (PPI) for endovascular treatment (ET) of acute ischaemic stroke (AIS) patients although a critical analysis has not been performed. To compare outcomes in AIS patients undergoing ET with or without PPI in two groups of patients: those with presence of aphasia; and those with admission NIHSS score of ≥20.

Methods All endovascular treated AIS patients were identified through a database maintained from two comprehensive stroke centres over an 8 year period. The rate of intra-procedural intubation in patients without PPI was ascertained. The rates of poor functional outcome at discharge (modified Rankin score [mRS] of ≥3) and intracerebral haemorrhage (ICH) were compared between those who did or did not undergo PPI in the two study groups.

Results In the first analysis, 60 (50%) of 120 patients with aphasia underwent procedure without PPI; 6 of 60 patients required intra-procedural intubation. The odds of any ICH [OR 6.3, 95% CI 1.6–24.0] and in-hospital mortality [OR 9.3, 95% CI 2.7–31.0] were significantly higher among those who underwent PPI after adjusting for potential confounders. In the second analysis, 36 (39%) of 93 patients with NIHSS score ≥20 underwent ET without PPI; 6 of 57 patients required intra-procedural intubation. The risk of any ICH (OR 7.6, 95% CI 0.9–67.8) and in-hospital mortality [OR 5.0, 95% CI 0.9–27.5] were higher among patients who underwent PPI, after adjusting for potential confounders. The rates of good outcome at discharge were significantly lower among those patients with aphasia [OR 0.1, 95% CI 0.04–0.2, p=<0.0001] or those with NIHSS score ≥20 [OR 0.07, 95% CI 0.005–0.9, p=0.04] who underwent PPI.

Conclusions Despite the risk of intra-procedural intubation among patients with either aphasia or admission NIHSS score ≥20 who undergo ET without PPI, the rates of poor outcomes, ICH, and death are prominently lower than those with PPI.

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